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  • History of CARF International

    CARF International was formed in 1966 by two national organizations -- the Association of Rehabilitation Centers (ARC) and the National Association of Sheltered Workshops and Homebound Programs (NASWHP) -- that had been developing standards for their respective memberships for about a decade. In September 1966, the two organizations agreed to pool their interests in setting standards and formed the Commission on Accreditation of Rehabilitation Facilities, now known as CARF International.

    In the years since its formation, the organization has steadily grown in size and stature. The following are some of the significant highlights in our history:

    September 1966 

    The ARC and the NASWHP (which later merged into the National Association of Rehabilitation Facilities) incorporated the Commission on Accreditation of Rehabilitation Facilities in the state of Illinois as a nonprofit organization.


    CARF accredited its first program in Canada.

    April 1970 

    The Council of State Administrators of Vocational Rehabilitation passed a resolution urging state agencies to work toward the goal of requiring all organizations providing rehabilitation services to be accredited by CARF. This was one of the key developments in the history of the Commission.

    November 1973 

    CARF published a new section of the standards manual for Rehabilitation Facilities, specifically identifying program evaluation standards. These standards became a springboard for extensive future activities by CARF in program evaluation.

    November 1974 

    Goodwill Industries of America moved to terminate its longstanding and exemplary efforts in standards setting and accreditation and recognized CARF as the accrediting organization for all Goodwill organizations.

    September 1976 

    CARF celebrated its first ten years of service and received a special congratulatory letter from President Ford in which he said, "The tenth anniversary of the Commission on Accreditation of Rehabilitation Facilities marks an important milestone for all Americans, and most particularly our disabled citizens. I welcome this opportunity to commend your leadership in this vital field."

    May 1979 

    President Carter recognized CARF for its significant efforts to upgrade the delivery of rehabilitation services to the nation's citizens with disabilities.

    November 1980 

    The Association of Trial Lawyers of America adopted a resolution urging state workers' compensation agencies to require CARF accreditation for rehabilitation organizations serving workers with occupational disabilities.

    April 1981 

    President Reagan congratulated CARF on its fifteen years of service and leadership in improving services for citizens with disabilities and recognized CARF as a national example of the private sector meeting public needs.

    January 1986 

    Standards for two new program areas were published in the 1986 Standards Manual for Organizations Serving People With Disabilities. The new program areas were Respite Programs and Alcoholism and Drug Abuse Treatment Programs.

    January 1988 

    The 1988 Standards Manual for Organizations Serving People With Disabilities included new standards in the areas of Post-Acute Brain Injury Programs and Community Mental Health Programs. In addition, the Commission renewed its emphasis on standards for program evaluation systems that emphasize quality.

    August 1991 

    CARF celebrated 25 years of service with a two-day conference in Washington, D.C. President Bush sent a letter of congratulations on this special occasion.

    January 1994 

    CARF reorganized its staffing pattern to emphasize three fields: Vocational and Employment/Developmental Disabilities, Medical Rehabilitation, and Alcohol and Other Drugs/Mental Health. For the first time a National Leadership Panel for each field was convened to assist CARF to proactively plan for and address current issues and trends impacting the provision of services to people with disabilities.

    January 1995 

    CARF published a separate volume of its 1995 Standards Manual and Interpretive Guidelines for each of its divisions -- Behavioral Health, Employment and Community Support, and Medical Rehabilitation.

    July 1995 

    New standards in the areas of Occupational Rehabilitation Programs and Comprehensive Pain Management Programs went into effect in the Medical Rehabilitation Division.

    August 1995 

    The CARF Board of Trustees approved CARF's ongoing collaboration with the Professional Services Board of the American Speech-Language-Hearing Association.

    January 1996 

    CARF published the first edition of the Accreditation Sourcebook.

    July 1996 

    In the Medical Rehabilitation Division, standards for a new program area, Home- and Community-Based Rehabilitation Programs, went into effect, along with revised standards in the areas of Brain Injury Programs, both Comprehensive Inpatient and Community Integrative, and Spinal Cord Rehabilitation System of Care.

    August 1996 

    CARF accredited its first program on the European continent. 

    January 1997 

    CARF signed a contract with the U.S. Department of Veterans Affairs to accredit all of its rehabilitation programs over a five-year period.

    July 1997 

    New standards in the areas of Health Enhancement Programs and Pediatric Family-Centered Rehabilitation Programs went into effect in the Medical Rehabilitation Division.

    September 1997 

    CARF was awarded a contract by the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) for the development and implementation of Opioid Treatment Program accreditation.

    July 1998 

    All the standards were rewritten to be unidimensional, which represented a step in CARF's initiative in implementing the Standards Conformance Rating System.

    The Accreditation Principles and the Accreditation Criteria were removed as separate sections in the manuals and incorporated into the standards. An Accreditation Condition was added that required an organization to submit a Quality Improvement Plan (QIP) within 90 days following notice of accreditation. CARF ceased offering a Twelve-Month Abeyance to organizations that fell short of a One-Year Accreditation on their first survey.

    November 1998 

    The pilot project of the collaborative partnership between CARF and the Workers' Compensation Board in Alberta began. The project addressed the quality and value of rehabilitation services that are delivered to injured workers in the province of Alberta.

    January 1999 

    CARF published standards manuals for Adult Day Services programs and also the Veterans Health Administration Comprehensive Blind Rehabilitation Services.

    July 1999 

    CARF began accrediting networks in Behavioral Health and Employment and Community Services fields through its Network Administration standards.

    The practice of disclosing information to the public regarding an organization's survey report, which previously applied only to organizations surveyed with the Medical Rehabilitation Standards Manual, was extended to organizations surveyed with the Behavioral Health Standards Manual and the Adult Day Services Standards Manual.

    February 2000 

    CARF published a standards manual for Assisted Living programs.

    July 2001 

    In the Employment and Community Services Division, standards for a new service area, Workforce Development Services, went into effect. Standards were published for One-Stop Career Centers.

    November 2001 

    CARF was recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Substance Abuse Treatment (CSAT) as an approved accrediting organization for Opioid Treatment Programs.

    September 2002 

    CARF Canada was incorporated in Edmonton, Alberta.

    February 2003 

    CARF acquired the Continuing Care Accreditation Commission (CCAC). Founded in 1985, CCAC accredits aging services continuums, including continuing care retirement communities and other organizations. CCAC was founded by the American Association of Homes and Services for the Aging (AAHSA) in Washington, D.C.

    The combination of two nonprofit accrediting organizations has created an independent resource that helps to identify high quality care providers -- from children's services to those for older adults.

    November 2003 

    The public information policy was extended to the Employment and Community Services unit and all others to which it did not already apply.

    January 2005 

    CARF published the Child and Youth Services Standards Manual from a compilation of existing standards already in use.  Areas highlighted include Child- and Family-Centered Care, Transition Support Services, Early Childhood Development, Behavioral Consultation, Child/Youth Day Care, Support and Facilitation, Child/Youth Protection, Congregate and Group Home Care, and Legal Permanency.

    December 2005 

    CARF accredited its first program in South America.

    January 2006 

    CARF published the Aging Services Standards Manual with Survey Preparation Questions for providers with Continuing Care Retirement Communities, Aging Services Networks, Adult Day Services, Assisted Living, or Stroke Specialty Programs. New program standards were developed for this manual for Person-Centered Long-Term Care Community. Stroke Specialty Programs standards were also implemented for Medical Rehabilitation providers.

    August 2006 

    Standards for Dementia Care were published for application to this special population in many settings, including adult day services, assisted living residences, nursing homes, and continuing care retirement communities.

    September 2006 

    CARF celebrated its 40th anniversary of accreditation services in the human service field. City of Tucson Mayor Walkup presented a plaque to the company.

    January 2007 

    The Comprehensive Blind Rehabilitation Services Standards Manual was updated and republished as the Vision Rehabilitation Services Standards Manual with two programs, Comprehensive Blind Rehabilitation Services and Comprehensive Vision Rehabilitation Services.

    February 2007 

    CARF began accrediting suppliers of certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). CARF's entry into this accreditation area followed the Centers for Medicare & Medicaid Services' (CMS) approval of CARF as a national deeming authority for DMEPOS suppliers.

    April 2007 

    uSPEQ® released the Consumer Experience Survey -- a turnkey data collection and reporting system designed to assist organizations with performance improvement.

    June 2007 

    CARF launched its extranet Customer Connect (

    October 2007 

    uSPEQ released the Employee Climate Survey -- a data collection and reporting system designed to assist organizations with performance improvement.

    Other 2007 milestones 

    The following sets of new standards were released:

    • Amputation Specialty Programs
    • Autism Spectrum Disorders
    • Comprehensive Benefits Planning
    • Crisis and Information Call Centers
    • Employment Recovery Services
    • Integrated Behavioral Health/Primary Care
    • Medication Monitoring and Management
    • Mentor Services
    • Self-Directed Community Supports and Services

    January 2008 

    CARF's ASPIRE to Excellence® quality framework is introduced in all standards manuals. In this framework, CARF's existing business practice standards were restructured to provide a logical, action-oriented approach to ensure that organizational purpose, planning, and activity result in the desired outcomes.

    Many of the program-specific standards for Medical Rehabilitation were significantly revised and new standards were added to expand accreditation opportunities across the continuum of services and specialty programs.

    June 2008 

    CARF introduced the ability to submit a Survey Application online.

    CARF accredited its first program in Oceania.

    November 2008 

    CARF accredited its first program in the Middle East.   

    December 2008   

    CARF International accreditation was recognized by the Ontario Ministry of Health and Long-Term Care.

    CARF Europe was incorporated in London, England, United Kingdom.

    Other 2008 Milestones   

    In early 2008, uSPEQ underwent another round of data. Both qualitative and quantitative analyses were conducted to validate the psychometric properties of the Consumer Experience Survey questionnaire. As a result, the Tier 1 universal items on the survey were streamlined to 20 questions. The Tier 2 optional items were enriched for various service providers.

    January 2009   

    CARF’s Child and Youth Services customer service unit’s growth prompted hiring the unit’s first managing director.

    June 2009  

    URAC and CARF International announced a new survey tool for healthcare case management studies. Developed using uSPEQ, uSPEQ-CM is a confidential, anonymous, and scientifically tested reporting system that gathers participants’ experiences with their case management program.

    CARF accredited its first program on the Asian continent.

    September 2009   

    CARF International accreditation was recognized by the Alberta Ministry of Health and Wellness. 

    February 2010 

    CARF accredited its first programs on the African continent. 

    July 2010  

    New standards for Home and Community Services went into effect in the Aging Services, Behavioral Health, CARF-CCAC, Child and Youth Services, Employment and Community Services, and Medical Rehabilitation accreditation areas. Home and Community Services standards were designed as a unique, broad, flexible framework and were published in multiple standards manuals. 

    January 2011 

    CARF introduced Medically Complex Population Designation standards for Behavioral Health and Child and Youth Services accreditation areas. Child and Youth Services also introduced Adoption standards. The new sets of standards can be applied on surveys beginning July 2011.

    May 2011 

    CARF Canada opened an office space in Toronto, Ontario. 

    January 2012 

    CARF International introduced standards for accreditation of Student Counseling, Independent Evaluation Services, and Supported Education. The new standards were published in the 2012 editions of the Behavioral Health, Medical Rehabilitation, and Employment and Community Services standards manuals, respectively. New standards for Case Management were also published in the 2012 editions of the Aging Services and CARF-CCAC standards manuals.

    July 2012 

    New standards for Health Home Services went into effect in the Behavioral Health accreditation area. 

    January 2013 

    CARF introduced standards for Eating Disorder Treatment programs in the Behavioral Health accreditation area. 

    January 2014 

    CARF introduced standards for Cancer Rehabilitation Specialty Program in the Medical Rehabilitation accreditation area. New standards for Peer Support Services were also published in the Behavioral Health, Child and Youth Services, Employment and Community Services, and Opioid Treatment Program standards manuals.

    December 2014 

    CARF Europe opened office space in London, England, United Kingdom.

    January 2016

    CARF published the CARF Standards Manual Supplement for Networks and the CARF Standards Manual Supplement for Employment Services Centres in Canada.

    The CARF–CCAC Standards Manual renamed to the Continuing Care Retirement Community Standards Manual.

    September 2016

    CARF celebrated 50 years of enhancing lives and services.

    May 2017

    CCAC entity and accreditation process fully integrated into CARF. CCAC name as an entity and the logo are no longer in use.

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